Language and Academic Outcomes for Early-Implanted Children with Bilateral versus

Unilateral Cochlear Implants

Julia Sarant, David Harris, Lisa Bennet, Laura Sinclair, Mansze Mok, Manasi Canagasabey, Sharyn Bant, Robert Cowan

Linkage project funded by the Australian Research Council &

Cochlear Ltd

Disclosure

Primary Author: Dr Julia Sarant Presenting Author: Prof Robert Cowan The University of Melbourne, Department of Audiology and Speech Pathology receives research funding from Cochlear Limited.

Study Aims

5-year longitudinal study (2009-2014): •  To investigate whether bilateral CIs at a young age give children a

greater ability to learn.

•  To provide some of the first data worldwide comparing the effects of two CIs on language, social & academic outcomes.

•  Do children with two CIs have: –  better language outcomes? –  better psychosocial outcomes? –  better academic outcomes? –  less disability, in terms of functional listening skills in daily life?

•  First CI by 3.5 years

•  Second CI under 6 years

•  Aged 5-8 years at some time during the study

•  Speak English as their primary language at home (some used supplementary sign)

•  Normal cognitive ability (IQ)

•  No other disabilities that would prevent completion of assessment tasks

Selection Criteria

•  Are outcomes age-appropriate?

•  Is there a significant difference in language outcomes between children with 1& 2 CIs?

•  What are the predictive factors for language outcomes? –  N = 91 ( 44 boys, 47 girls) aged 5-8 years –  67 bilateral CIs –  24 unilateral CIs (19/24 used a HA also)

Language

Statistical Analysis

Hearing Parenting Style Child Characteristics Family Background

Age @ CI1 (yrs) Parent involvement Birth order Parent education

Age @ CI2 (yrs) Screen time IQ FH hearing loss

CI experience

Adult reading time Birth weight (kg) FH reading difficulties

Gender FH speech difficulties

Age @ diagnosis Fine motor skills

Language at 5 years: PLS-4

N = 56 (41 bilateral, 15 unilateral) Bilateral Unilateral

Language at 8 years:CELF-4

N = 35, p = 0.002 (EL), 0.004(CL)

* *

Bilateral Unilateral

Vocabulary (PPVT): All children

N = 91, p = 0.0004

*

Bilateral Unilateral

Language: Predictive Factors

Predictive Factors 5 years 8 years Vocabulary Bilateral CIs √ √ Younger @ CI2 √ √ √ Younger @ CI1 √ √ Higher parent involvement √ √ Less screen time √ √ More adult reading time √ √ Earlier birth order √ √ √ Higher IQ √ √ Higher birth weight (kg) √ Female gender √ Higher parent education √ FH of hearing loss √

√ = p<0.05

Age appropriate? •  Group mean scores always within 1SD of mean for bilateral

children, but not for younger (5yo) unilateral children Bilateral vs Unilateral: •  Significantly better language outcomes for older (8yo)

children, but not for younger children •  Bilateral use predicted better language outcomes

(moderated by age at CI2) Predictive factors: •  Outcomes were significantly predicted by factors related to

parenting, child characteristics & family background 59-69% of variance predicted by the regression models

Summary – Language Outcomes

•  Are outcomes age-appropriate?

•  Is there a significant difference in academic outcomes for children with 1 & 2 CIs?

•  What are the predictive factors? –  N = 44 ( 23 boys, 21 girls) aged 8 years –  34 bilateral CIs –  10 unilateral CIs (7/10 used Has also)

Academic Outcomes

•  Wechsler Individual Academic Achievement Test

•  Broad range of academic skills in 4 composite areas: –  Oral Language –  Written Language –  Maths –  Reading

•  Age-based standard scores

•  1.5 - 2 hours administration time

WIAT –II Academic Assessment

Academic Outcomes

•  N = 44

N = 44

* *

*

Bilateral Unilateral

WIAT-II: Predictive Factors

Predictive Factors Oral Lang Maths Written Lang

Reading

Bilateral CIs √ √ √ √ Younger @ CI2 √ √ √ √ Younger @ CI1 √ √ Hearing aid use √ √ √ √ Higher parent involvement √ √ √ √ Earlier birth order √ Higher IQ √ √ Higher birth weight (kg) √ Higher parent education √ Time spent reading √ √ √ FH of speech/reading difficulties √ √

√ = p<0.05

•  Children with CIs can achieve language & academic outcomes within the normal range

•  Bilateral CIs predict significant benefits to language & academic development

•  Bilateral benefit across all outcomes is maximized with earlier age at implantation.

•  Practical findings of clinical relevance include the importance of parental involvement & of children developing a regular reading habit

•  Hearing aid use before & after implantation very important •  Although we have come a long way over the past decade, there

is still room for improvement

Conclusions

•  Participating families

•  Collaborative centres: Melbourne Cochlear Implant Clinic (RVEEH), The Shepherd Centre, The Hear & Say Centre, The Cora Barclay Centre, Sydney Cochlear Implant Clinic, The Women’s & Children’s Hospital, Hearing House, New Zealand

•  LOCHI Study

•  Australian Research Council & Cochlear Ltd

Thank you to…

Julia Sarant, PhD Senior Research Fellow Department of Audiology & Speech Pathology The University of Melbourne Australia jsarant@unimelb.edu.au +61 03 9035 5325

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